It's extremely difficult to study the effects of sleep deprivation on the rate of medical error, but several studies have shown that the highest numbers of medical errors occur during handoffs between shifts. Reducing the frequency of those handoffs by increasing shift length reduces the total number of detectable medical errors.

Additionally, the work hour restrictions placed on residents over the last few years appear to have done nothing to reduce the overall number of medical errors.

(I am in favor of reducing medical work hours myself, but these are some of the data-driven reasons that it will be very difficult, not to mention the structural reasons inherent to the current system of medical training.)

By having more doctors working less intensely for overlapping shifts, they can take more time to complete handoff documentation and conversations properly, and have fewer handoffs (by taking on fewer patients after the first half of their shift)

Longer shifts does not mean that doctors can't have longer sleep that 4 hours. Let doctors have 16 or even 18-hour long shifts interleaved with days without shifts at all, for sleeping and some [light] paperwork.

This is, I believe, how firefighters work: long shifts of oncall where they live in the firehouse, separated by longer periods of non-work (rest, sleep, whatever).

One solid reason is the same reason sleep deprivation is used in basic training. Most doctors, will, at some point in their life, have to make life and death decisions when they're operating far from 100% ... or at least that was true back in the days when they'd take calls at any hour of the day (as late as the '70s). Less dire, they have office hours they must keep unless they're really sick, and they certainly won't be at 100% every day.

So this is useful training, albeit at a cost. Although if they make a mistake that kills a patient during residency and learn they can't deal with the consequences of that, I suppose the earlier the better. They can of course move to less life and death specialties.

I get that deprivation training can be helpful, but to be deprived nearly 100% of the time in a safety critical, fast paced environment? That's crazy. These guys aren't special forces (who I assume have in-field careers similar to pro-sports players), they're normal people trying to work at this for many decades.

If your goal is to reduce medical errors, create systems that don't depend on a single person's fluctuating energy level (e.g. have two doctors responsible for each patient, keep patient loads low enough that they can deal, automate as much as possible with computer systems (e.g. billing), and delegate to e.g. PAs for mundane diagnoses). Exhausted people make mistakes, can't work or think as quickly, are less creative, and are generally less happy. All the technology in the world won't help you if the key decision makers screw up at the wrong time.

After all, coffee does exist for those times when your natural energy level won't do it for you. ;)

A nit, in the military this is not limited to "special forces", and I'm just talking about the stresses of peacetime. Look at e.g. https://en.wikipedia.org/wiki/Watch_system which doesn't list the 4 hours on, 4 hours off system the US Navy used, at least in the '50s when my father was First Lieutenant on a North Atlantic radar picket ship. He still remembers it being very hard.

This is interesting. Thanks for the link!

Nonetheless, I don't think these guys are getting 4 on 4 off... I think they just work basically straight through for 12-16 (or more) hours and get maybe a day a week off.

I can completely sympathize though that 4 on 4 off would be incredibly hard in and of itself. I'm not sure I could do it for weeks let alone months on end.

So... possibly put real patients at risk on a regular basis in order to train doctors for hypothetical situations that they may face at some point in their career? That doesn't sound like a solid justification to me.

Not sure why you were downvoted, but this is the exact reason that a couple of my relatives in medical profession gave when asked why their training involved 24-36 hour shifts routinely with very few sleep breaks.

I think it makes sense in training (under supervision), it's just doing it as an all encompassing lifestyle that I think makes no sense.

Well, the downvoting didn't stick.

I learned this primarily from my mother, who was a RN nurse anesthetist, and a doctor who became my father's primary hunting partner about the time I was old enough to start actively hunting.

It is a logical argument but it's far from "solid" given today's realities. Humans simply don't adapt to sleep deprivation and organized, constant sleep deprivation clearly is going to make decisions worse over time.

There's no justifiable reason to give a large, urban hospital an organization system fit to the battle field.

> Maybe medical school prices would go down with additional scale.

It seems like a bit of a chicken and egg problem. Medical school is already so expensive that the salaries are necessary in order for newly minted doctors to have the same disposable income after loan payments that, say, a programmer or chemical engineer who's 7 years younger has (4 years medical school + 3 years residency minimum). Who would make the sacrifices necessary to become a doctor, taking out massive loans, only for an income that won't sustain them comfortably?

So, Apple suppressing engineer wages indirectly made the medical profession more attractive for doctors!